Reduction in Time-to-Diagnosis for Lung Cancer Resulting From Implementation of a Formal Incidental Pulmonary Nodule...

Incidental pulmonary nodules (IPN) are nodules identified on imaging performed for a reason unrelated to the diagnosis of cancer. This study analyzes improvement in time-to-diagnosis for patients first presenting with an IPN that was later diagnosed as lung cancer through a formal IPN program.

This is a 5-year retrospective, single-center analysis of outcomes for IPN patients diagnosed with lung cancer who presented through a formal IPN program (FIP) pathway compared with a matched group of patients diagnosed with lung cancer presenting through traditional IPN referral (TIR) pathway. The primary endpoint was time-to-diagnosis of lung cancer. A chart review was performed to determine the date of the initial CT scan identifying the IPN to the date of the procedure to diagnose lung cancer in the FIP group and the TIR group. The number of days from identification of the IPN to diagnosis was compared between the 2 groups.

Between May 2019 and May 2024, a total of 9303 patients were identified with IPNs through the formal IPN program. Ninety-six of these patients (1%) were diagnosed with cancer following nodule biopsy. Eighty-one of the patients (84%), making up the FIP group, were diagnosed with primary lung cancer. Twenty-one of the 81 primary lung cancer patients in the FIP group (27%) were diagnosed with early-stage disease and underwent curative resection. The average time from identification of an IPN to diagnosis of lung cancer in the FIP cohort was 43 days. The average time from identification of the IPN to diagnosis of lung cancer in the TIR cohort was 177 days. There was a 134-day difference between the 2 groups from identification of an IPN to diagnosis of lung cancer.

Implementation of a formal IPN program can reduce time-to-diagnosis of lung cancer in patients presenting with an IPN by 134 days compared with traditional referral patterns. Formal IPN programs can result in a shift towards an earlier stage of diagnosis for lung cancer.